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Typhus in the Victorian City

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Typhus in the Victorian City Medical History, 1988, 32: 401-425. URBAN FAMINE OR URBAN CRISIS? TYPHUS IN THE VICTORIAN CITY by ANNE HARDY* There were four horsemen of the Apocalypse: War, Famine, Disease and Death, a historic association which has continued into modern times. For most of history, the disease most commonly linked with this awful partnership has been typhus, and typhus has become known as the archetypal famine fever. The aetiology of the disease has, however, rarely been examined in its historical context; as a result, historians have often misinterpreted its significance. In one recent article, for example, the disease was treated as an indicator ofurban famine, ofthe extent to which the nutritional status of the Lancashire textile operatives was reduced by the Cotton Famine of the 1 860s. 1 In the nineteenth century, however, epidemics of typhus occurred in both times of stress and times of prosperity: unlike its cousin, relapsing fever, typhus is not a primary indicator of "true, nutritional famine". Why did typhus disappear as a significant cause of death in the late nineteenth century? The disease was almost certainly endemic in pockets ofcities across Britain in the eighteenth and early nineteenth centuries; from time to time there were epidemic outbreaks. What were the different factors that permitted the survival of the disease, stimulated epidemics, and finally led to its virtual disappearance in the 1870s? The commonly-assumed causal link between typhus and famine, or at least malnutrition, raises the question of dearth and living standards in the nineteenth century. The harvest-related subsistence crisis had vanished by the late eighteenth century; but do typhus epidemics indicate periods of dearth in nineteenth-century cities? Or was typhus's survival rather a question of hygiene? For the urban historian H. J. Dyos, typhus was an indicator of "dirt and destitution"; for Thomas McKeown, of malnutrition and low levels ofpersonal hygiene.2 The answer is perhaps more complex: in a recent analysis ofthe European subsistence crisis of 1740 John Post has argued that the links between food shortages and disease are more social than nutritional, that typhus is not an indicator of famine per se, but the consequence of social dislocation *Anne Hardy, D.Phil., 22 Norham Road, Oxford OX2 6SF. l D. Oddy, 'Urban famine in nineteenth-century Britain', Econ. Hist. Rev., second series, Feb. 1983, 37: 83. 2 H. J. Dyos, 'Some historical reflections on the quality of urban life', in David Cannadine and David Reeder (editors), Exploring the urban past. Essays in urban history by H. J. Dyos, Cambridge University Press, 1982, p. 72; Thomas McKeown, The modern rise of population, London, Edward Arnold, 1976, pp. 126, 132, 141. 401 Downloaded from https://www.cambridge.org/core. IP address: 170.106.202.8, on 30 Sep 2021 at 07:55:01, subject to the Cambridge Core terms of use, available at https://www.cambridge.org/core/terms. https://doi.org/10.1017/S0025727300048523 Anne Hardy produced by harvest failure and distress.3 In such social crises, patterns of human behaviour alter; and increased mobility, domestic crowding and reduced personal hygiene result in epidemics. The behaviour of epidemic typhus in the nineteenth century supports this argument: the disease survived as long as social dislocation continued to be an intermittent feature of urban life, before rising and stabilizing real wages reduced the impact of economic upheavals on the lives of the working classes. The language of urban crisis, of subsistence crisis, and of urban famine, generally appears in the historiography of the pre-industrial world,4 and is rarely applied to the nineteenth century. Historical debates about dearth and disease in the later eighteenth and nineteenth centuries centre on long-term issues, especially that of the extent to which improving-or stationary, or regressing-nutritional status influenced long- term trends in mortality from a range of endemic and epidemic diseases.5 In this debate, the mortality crises which continued to occur in individual cities, and the diseases which caused them, have received relatively little attention.6 Yet local studies may help our understanding of the mechanics of mortality change. Recent American research shows a correlation between short-term variations in urban mortality and the business cycle. The relationship is said to hold for both major epidemics and other diseases, and to be closely related to the pattern of European immigration:7 the epidemiological peaks illustrate the pattern of social and economic dislocation. Although this model is not entirely applicable to Britain, typhus is a disease of social dislocation, and its survival as an epidemic disease in England as late as the 1860s reflects not simply or necessarily hunger, but the complex social consequences of the inherent instability of an emergent industrial economy.8 If "urban crises" are seen as continuing into the nineteenth century, the circumstances in which typhus epidemics occurred may throw further light on mortality decline, and on the role ofnutrition in this decline. This paper contends that typhus has a significance beyond nutritional levels. In terms of social history, Victorian typhus illustrates the social and economic insecurity ofurban life up to the 1870s, and the way 3 John D. Post, Food shortage, climatic variability, and epidemic disease in preindustrial Europe; the mortalitypeak in the early 1740s, Ithaca, Cornell University Press, 1985; see also, idem, 'Climatic variability and the European mortality wave of the early 1740s', J. interdisciplinary Hist., summer 1984, 15: 1-30. Among4 a large literature, see for example, Peter Clark and Paul Slack, English towns in transition, Oxford University Press, 1976; Charles Pythian-Adams and Paul Slack, Urban crisis or urban change?, Milton Keynes, Open University, 1977; John D. Post, The last great subsistence crisis in the Western world, Johns Hopkins University Press, 1977; Paul Slack, The impact ofplague in Tudor and Stuart England, London, Routledge and Kegan Paul, 1985, chapter 3. 5 The literature includes F. W. Notestein, 'Population-the long view', in T. W. Schultz (editor), Foodfor the world, Chicago University Press, 1945, pp. 36-57; T. McKeown and Record, 'The decline ofmortality in the 19th century', Population Stud., November 1962, 16: 98-122; McKeown, op. cit., note 2 above; A. B. Appleby, 'Nutrition and disease: the case of London, 1550-1750', J. interdisciplinary Hist., summer 1975, 6: 1-22; and the essays in the following Special Issues of J. interdisciplinary Hist.: 'Hunger and history', autumn 1983, 14, no. 2, and 'Population and history', spring 1985, 15, no. 4. 6 Ofthe diseases which caused such crises, only cholera has been examined in detail. Cholera incidence is unrelated to nutritional status, and the disease was, like plague before it, an "invader": the term is used by Slack, op. cit., note 4 above, p. 14. 7 R. Higgs, 'Cycles and trends of mortality in 18 large American cities, 1871-1900', Explor. Econ. Hist., 1979, 16: 381-408. 8 L. D. Schwarz, 'The standard of living in the long run: London, 1700-1860', Econ. Hist. Rev., second series, 1985, 38: 32. 402 Downloaded from https://www.cambridge.org/core. IP address: 170.106.202.8, on 30 Sep 2021 at 07:55:01, subject to the Cambridge Core terms of use, available at https://www.cambridge.org/core/terms. https://doi.org/10.1017/S0025727300048523 Typhus in the Victorian city in which local economic conditions helped to determine outbreaks of disease; on the medical side, typhus's independence of nutritional status explains both its unpredictable appearances, and its disappearance from England at a time when the nutritional- and, probably, the hygienic level of the "submerged tenth" remained relatively unchanged.9 I By the nineteenth century, typhus had become an essentially urban disease ofsporadic outbreaks, in England and elsewhere. Throughout the century, Liverpool in particular continued to provide "a habitation and a name" for the disease.'0 Nevertheless, in the 1870s typhus mortality entered a decline which can now be seen to have been final. The social associations of typhus suggest reasons for its disappearance, but do not fully explain its epidemic pattern. In an attempt to understand why epidemic typhus disappeared in the later nineteenth century, circumstances in London, a city where the disease was almost endemic and repeatedly epidemic in the earlier part ofthe century, are here examined more closely. London experienced a major, but final, typhus epidemic in 1861-69. Offour previous epidemics during the century, three had been associated with economic depression, and the other with the potato famine of 1847-48.1" The epidemic of 1861 began without any obvious trigger; indeed, it began in London in December 1861, but in Lancashire in October 1862. It is clear that in the 1860s London was a city under stress; this condition was not without parallel in other English cities, but it was unrelated to any wider, national economic cnsis. Gareth Stedman Jones has shown that there was a continuing economic crisis in London's East End in the 1860s. It began with the final decline of the silk-weaving industry, was compounded by the collapse of the Poplar ship-building industry in 1866, and its social effects were aggravated by house demolitions making way for factory- and warehouse building, improvement schemes, and railway construction. 12 The last was not limited to the East End, and in 1860 distress had been increasing generally
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